Provider Demographics
NPI:1346937778
Name:MALKIE GOLD RD LLC
Entity Type:Organization
Organization Name:MALKIE GOLD RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:YACHAT
Authorized Official - Middle Name:MALKA
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:845-641-9442
Mailing Address - Street 1:47 ROCKEFELLER DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4340
Mailing Address - Country:US
Mailing Address - Phone:845-641-9442
Mailing Address - Fax:
Practice Address - Street 1:47 ROCKEFELLER DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4340
Practice Address - Country:US
Practice Address - Phone:845-641-9442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty